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All Of Your Information Is Kept Safe With Me. ...This Form Is for Verification Purposes Only and My SAFETY!
How did you FIRST hear about me?
(Required)
(you can check more than one)
Tryst.link
Eros.com
Twitter
Instagram
TER (the erotic review)
P411 (Preferred 411)
NaughtyJade.com (my adult website)
Slixa.com
Other
Other
Name
(Required)
(Please Enter First and Last Name in FULL) No Initials Please
First
Last
D.O.B
(Required)
Month
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Email
(Required)
(must be accurate to contact you)
Enter Email
Confirm Email
Cell Phone
(Required)
(must be accurate to text before our meeting)
Is it Ok to text ?
(Required)
Yes
No
Please Tell Me Where You Live In Case I'm Touring Your City In The Future
(Required)
(Please Select the City Closest To YOU)
Please select
Atlanta
Austin
Baltimore
Birmingham
Boston
Buffalo
Charlotte
Chicago
Cincinnati
Cleveland
Columbus
Dallas-Fort Worth
Denver
Detroit
Hartford
Houston
Indianapolis
Jacksonville
Kansas City
Las Vegas
Los Angeles
Louisville
Memphis
Miami
Milwaukee
Minneapolis-St. Paul
Nashville
New Orleans
New York
Oakland
Oklahoma City
Orlando
Philadelphia
Phoenix
Pittsburgh
Portland
Providence
Raleigh
Richmond
Riverside-San Bernardino
Sacramento
Salt Lake City
San Antonio
San Diego
San Francisco
San Jose
Seattle
St. Louis
Tampa
Virginia Beach-Norfolk
Washington, DC
Cities That I Am Available In
(Required)
Please Select A City Where You Would Like to Book Me
Please select
Tampa (Dec. 1 - Mar 1, 2023)
Other
Please Enter City
(Required)
If you wish to leave a message, please enter below:
Duration Of Date
(Required)
Please select
1 hr - $1,500
2 hrs - $2,500
3 hrs - $3,500
4+ hrs - ($1,000 each addt'l hr)
Overnight (12 hrs) - $8000 (hotel and airfare not included)
1 Day (24 hrs) - $14000 (hotel and airfare not included)
2 Days - Please Inquire For Rates
3 Days - Please Inquire For Rates
Location
(Required)
*My Incall location is in the Tampa area OR my Hotel Room (If I'm Touring Your City).
INCALL*
OUTCALL
Where is your location?
(Required)
Time
(Required)
Please select
11:00 am
12:00 pm
12:30 pm
1:00 pm
1:30 pm
2:00 pm
2:30 pm
3:00 pm
3:30 pm
4:00 pm
4:30 pm
5:00 pm
5:30 pm
6:00 pm
6:30 pm
7:00 pm
7:30 pm
8:00 pm
8:30 pm
9:00 pm
9:30 pm
10:00 pm
10:30 pm
11:00 pm
Available For Appointments 11 am - 11 pm
Date Of Appointment
(Required)
MM slash DD slash YYYY
What information will you be providing for verification?
(Required)
**PLEASE NOTE: If you do not have a provider reference or belong to a verification website then you will be asked for personal information such as employment, home or business address, and/or photo identification. (You will be discreetly verified)
P411 (Preferred 411)
Provider Reference
I do not have provider references or belong to a verification website**
If you wish to leave a message, please enter below:
Provider Reference: ONLY Reputable Providers with Recent Reviews.
Provider Reference #1 (Name)
(Required)
Website
Email
Phone
Please enter when you saw her and something about yourself that she will remember you by if possible.
Provider Reference #2 (Name)
Website
Email
Phone
Please enter when you saw her and something about yourself that she will remember you by if possible.
VERIFICATION WEBSITES
Please enter one or more Verification ID’s in one of the following down below. (the more the better)
P411 (Preferred 411)
(Required)
If you wish to leave a message, please enter below:
Email
This field is for validation purposes and should be left unchanged.
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